The Impact of Corticosteroids on Secondary Infection and Mortality in Critically Ill COVID-19 Patients

Abstract

Background: Corticosteroids are part of the treatment guidelines for COVID-19 and have been shown to improve mortality. However, the impact corticosteroids have on the development of secondary infection in COVID-19 is unknown. We sought to define the rate of secondary infection in critically ill patients with COVID-19 and determine the effect of corticosteroid use on mortality in critically ill patients with COVID-19. Study Design and Methods: One hundred and thirty-five critically ill patients with COVID-19 admitted to the Intensive Care Unit (ICU) at the University of Maryland Medical Center were included in this single-center retrospective analysis. Demographics, symptoms, culture data, use of COVID-19 directed therapies, and outcomes were abstracted from the medical record. The primary outcomes were secondary infection and mortality. Proportional hazards models were used to determine the time to secondary infection and the time to death. Results: The proportion of patients with secondary infection was 63%. The likelihood of developing secondary infection was not significantly impacted by the administration of corticosteroids (HR 1.45, CI 0.75-2.82, P = 0.28). This remained consistent in sub-analysis looking at bloodstream, respiratory, and urine infections. Secondary infection had no significant impact on the likelihood of 28-day mortality (HR 0.66, CI 0.33-1.35, P = 0.256). Corticosteroid administration significantly reduced the likelihood of 28-day mortality (HR 0.27, CI 0.10-0.72, P = 0.01). Conclusion: Corticosteroids are an important and lifesaving pharmacotherapeutic option in critically ill patients with COVID-19, which have no impact on the likelihood of developing secondary infections.

Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

“…Likewise, a recent systematic review revealed that 53% of CAPA patients were on steroid therapy; therefore, a hypothetical correlation was suggested to exist between steroid use and the development of CAPA infection [79,80]. Ritter et al 2021 challenged this hypothesis through their single-centre experience, as they found that the hazard ratio of secondary infections due to corticosteroid administration was only 1.45 (CI 95%: 0.75-2.82; p = 0.28) among critically ill COVID-19 patients; therefore, they recommended that corticosteroids as an effective therapy for COVID-19 should not be discontinued due to the suspicions of secondary infection [81].…”

Early steroids and ventilator-associated pneumonia in COVID-19-related ARDS

“…The incidence of VAP in patients with COVID-19 has varied from 40 to 60% [ 13 , 14 , 18 ]. This range is higher than in patients with ARDS not related to COVID-19 [ 19 ].…”

Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis

“…There are occurrences of secondary bacterial infections that came with tocilizumab use but these cases had not led to deaths [63]. The corticosteroids in contrast, despite their immune-modulating action, seldom led to secondary infections but may cause hyperglycemia and may potentially lead to the onset of diabetes [64][65][66]. But weighed against the almost equal benefits of both drugs and the combination of the two in COVID-19 mortality reduction as seen in this review, their use as key COVID-19 treatment modalities is strongly justified.…”